NURS 6550 Final Exam

NURS 6550 Final Exam


1. Jan is a 39-year-old female who presents with significant right upper quadrant pain of 18 hours duration. She admits to a few episodes of vomiting. She right upper quadrant pain to palpation but the ultrasound is negative. Jan admits that this has happened before, usually when she “eats a huge meal.” The AGACNP orders which diagnostic study to confirm the diagnosis of cholecystitis?

A. Upright abdominal radiography

B. Hepatic function panel

C. HIDA scan

D. Abdominal CT


1. L.W. is a 41-year-old woman with a history of systemic lupus erythematosus which has been managed primarily with symptom control. Today she presents for evaluation of fatigue which has been slowly progressive over the last few months. She has a history of gastric bypass surgery 10 years ago and has maintained a 100 lb weight loss, but she maintains that she has been very adherent to her vitamin and mineral replacement regimen. Other than chronically heavy menses, for which she takes hormonal contraception, she is without complaint. A complete blood count is as follows:

Hgb 10.3 g/dL
Hct 31%
MCV 88 fL
RDW 15%

The AGACNP suspects that the patient’s fatigue is most likely due to:

A. Iron deficiency anemia

B. Anemia of chronic disease

C. Pernicious anemia

D. Folic acid deficiency


1. A patient presents for follow up after being started on an ACE inhibitor for hypertension. Her blood pressure has improved, but her pulse is 56 b.p.m down from 76 b.p.m. at her last visit. The AGACNP knows that the patient should assessed for:

A. Hypercalcemia

B. Hypernatremia

C. Hyperkalemia

D. Hyperchloremia


1. A young-adult male patient was dropped off outside of the emergency department and some staff members brought him inside. The patient is restless, irritable, and either unwilling or unable to participate in her own care. No history is available. His vital signs are essentially stable, finger stick blood sugar is 111 mg/dL, there are no signs of trauma, and no physical findings consistent with common drug or alcohol use. A toxicology screen is pending. The AGACNP orders acute psychiatric stabilization with a combination of haloperidol and lorazepam and considers which of the following mediations to decrease the risk of adverse effects?

A. Risperidone

B. Olanzapine

C. Benztropine

D. Zolpidem


1. Amy is a 21-year-old female who presents with acute nephrolithiasis. CT scan reveals a 2 mm stone in the left ureter. The AGACNP knows that the appropriate course of action is:

A. Pain control and IV fluid

B. Consultation for stent placement

C. Lithotripsy stone destruction

D. Transurethral stone destruction


1. B.T. is a 49-year-old male being admitted for lung volume reduction surgery. His preoperative pulmonary function tests are as follows:

FVC 66% predicted

FEV1 60% predicted

PEFR 69% predicted

TLC 104% predicted

RV 90% predicted

The AGACNP knows that the pulmonary function studies are consistent with:

A. Mild restrictive disease

B. Moderate restrictive disease

C. Mild obstructive disease

D. Moderate obstructive disease


1. A 30-year-old male patient presents for evaluation of a lump on his neck. He denies pain, itch, erythema, edema, or any other symptoms. He is concerned because it won’t go away. He says, “I noticed it a few months ago, then it seemed to disappear, and now it is back.” The AGACNP proceeds with a history and physical exam and concludes which of the following as the leading differential diagnosis?

A. Subclinical infection

B. Non-Hodgkin’s lymphoma

C. Catscratch disease

D. Syphilis


1. Ms. Teller presents with a chief complaint of weight loss. She reports an unplanned 10 lb weight loss over the last 5-6 months. She has no significant medical history, but review of systems reveals bilateral shoulder discomfort and some impaired range of motion—she has trouble pulling clothing over her head. Over the last few months she has generalized upper body stiffness, but seems to get better after an hour or so of activity. When considering a diagnosis of polymyalgia rheumatica, laboratory assessment may be expected to reveal:

A. An erythrocyte sedimentation rate (ESR) of 75 mm/hr

B. A microcytic, hypochromic anemia

C. Elevated liver function enzymes

D. Positive antinuclear antibodies


1. When a patient has lower abdominal discomfort, cervical wall motion tenderness, and adnexal tenderness, the AGACNP knows that this will likely be treated with:

A. Ceftriaxone and azithromycin

B. Metronidazole and ciprofloxacin

C. Trimethoprim/sulfamethoxazole

D. IV fluid and pain control


1. J.L. is an 81-year-old female who is admitted from home after her daughter found her confused and unkempt. She is not a good historian, and her daughter cannot provide any information—when she saw her mother a week ago, she was fine. J.L.’s vital signs are as follows: Temperature 101.4° F, pulse 99 b.p.m., respirations 22 b.p.m., and blood pressure 90/58 mm Hg. Her urinalysis is shows +++ leukocytes, + RBC, and + nitrites. Her metabolic panel reveals a BUN of 39 mg/dL and creatinine of 1.5 mg/dL. The AGACNP knows that J.L has findings consistent with:

A. Pre-renal failure

B. Intra-renal failure

C. Post-renal failure

D. Chronic renal failure


1. Patients with giant cell arteritis are at increased risk of:

A. Cerebrovascular accident

B. Rheumatoid arthritis

C. Polymyalgia rheumatica

D. Osteoarthritis


1. The AGACNP is called to the bedside for a patient who is in cardiopulmonary arrest. The monitor demonstrates ventricular fibrillation which will not convert despite several attempts to defibrillate at maximal voltage. While being briefed by the staff nurse on the patient medical history, he learns that the patient has a history of Cushing’s syndrome. The AGACNP recognizes that the patient is probably failing to convert due to:

A. Advanced atherosclerotic disease

B. Hypokalemia

C. Hypocalcemia

D. Catecholamine excess


1. When performing an evaluation of a patient following seizure activity, the AGACNP knows that the most important component of that evaluation is:

A. A CT scan of the head

B. Eyewitness description


D. Administering a benzodiazepine


1. Which of the following etiologic organisms is most likely to appear as lobar consolidation on chest radiography?

A. Legionella pneumophilia

B. Streptococcus pneumoniae

C. Pneumocystis carinii

D. Mycoplasma pneumoniae


1. A patient with chronic kidney disease presents with an eGFR of 30 mL/min/1.73m2. The AGACNP knows that the most compelling implication of this value is:

A. Control of risk factors for renal deterioration

B. Careful attention to renal dosing of medications

C. Referring the patient for shunt placement

D. Preventing occurrence of renal ischemia


1. Differential diagnosis of hematuria include all of the following except:

A. Bladder cancer

B. Nephrolithiasis in the renal parenchyma

C. Urinary tract infection

D. Prerenal azotemia


1. A 29-year-old male patient presents with acute scrotal pain and dysuria. He has a temperature of 101.8° F and a pulse of 115 b.p.m. but otherwise vital signs are within normal limits. He gets some relief of the scrotal discomfort when his scrotum is elevated on a rolled towel. This is known as:

A. Varicocele

B. Prehn’s sign

C. Cremasteric sign

D. Testicular torsion


1. The AGACNP knows that patients with psoriasis are at greater risk for:

A. Arthritis

B. Eczema

C. Cellulitis

D. Melanoma


1. Mr. McCarran is a 68-year-old male with a long history of poorly controlled T2DM. He has had progressive burning pain in both feet for the last year or so, but in the last few months it has become increasingly worse. He has tried taking ibuprofen and naproxyn over-the-counter with no improvement. Now, he is presenting for more effective pain management. The AGACNP knows that the medication of choice will be from which drug class?


B. Opiates

C. Antiepileptics

D. Anesthetics


1. Mr. Starwood is a 61-year-old male who was admitted last night for the management of acute pancreatitis. He was admitted n.p.o and started on intravenous fluid and opiate pain management. This morning he reports feeling significantly better. His C-reactive protein this a.m. is 5 mg/dL, amylase and lipase are both just over 2 x upper limits of normal, and his Ransom score is 2. The AGACNP knows that the next step in his care is to:

A. Begin clear liquids as tolerated

B. Order an abdominal CT

C. Order an ERCP

D. Continue the current management for 24 hours


1. When beginning pharmacotherapy for depression, the AGACNP discusses with the patient that a primary safety consideration includes the:

A. Increased risk of suicide when patients begin antidepressant therapy

B. Potential for sexual adverse effects

C. Better likelihood of success when medications and therapy are used together

D. High incidence of serotonin syndrome


1. When ruling out meningitis in a patient, the AGACP appreciates that the spinal fluid is cloudy and the glucose content is 20 cells/microliter. This is most consistent with:

A. Aseptic meningitis

B. Septic meningitis

C. Chemical meningitis

D. Chronic meningitis


1. A 44-year-old male patient presents in a hypertensive crisis. The blood pressure is 240/136 mm Hg, pulse is 128 b.p.m. and the patient is complaining of a severe, pounding headache. His skin is diaphoretic and he is visibly tremulous. The first diagnostic study to evaluate the suspected diagnosis should be a:

A. 24 hour urine for catecholamine metabolites

B. Serum epinephrine and metanephrines

C. T scan of the abdomen

D. MRI of the abdomen


1. An unidentified patient is brought to the emergency department by ambulance after being hit by a motor vehicle. She has multiple injuries and an estimated blood loss of 2 liters. The hematocrit is 19%. The AGACNP expects that the mean cell volume (MCV) would most likely be:

A. 70 fL

B. 80 fL

C. 90 fL

D. 110 fL


1. Mrs. Oliver is a 71-year-old petite Caucasian female. During a routine dexa screening she was found to have a T-score of -3.0. The AGACNP knows that the first intervention should include:

A. Calcium

B. Vitamin D

C. Bisphosphonates

D. Estrogen


1. When evaluating a family with suspected carbon monoxide exposure, the AGACNP knows that assessment should include all of the following except:

A. Vital signs

B. Pulse oximetry

C. Cardiac rhythm strip

D. Carboxyhemoglobin level


1. Mr. Riley is a 61-year-old male who just had bilateral knee replacements. There was more fluid loss than intended during the procedure. The AGACNP knows that metabolic alkalosis is the most common postoperative acid-base imbalance and is best treated with:

A. Normal saline infusion

B. An insulin drip

C. Low volume hydrochloric acid

D. Albumin


1. Patients in advanced stages of chronic kidney disease are at greatest risk for which of the following conditions?

A. Polycythemia

B. Hypokalemia

C. Metabolic alkalosis

D. Anemia


1. The diagnostic study of choice in mesenteric ischemia is:

A. Ultrasound

B. CT angiography

C. MR angiography

D. Diagnostic peritoneal lavage


1. Mr. Maxwell is a 58-year-old male who presents with left foot pain. Physical examination reveals a foot that is normal in appearance with DP and PT pulses that are barely audible by Doppler. The AGACNP has the patient cross the leg with the left foot resting on the right knee; after 30 seconds that left foot is briskly lowered to the floor. Instantly the left foot turns bright red. This is known as:

A. Venous insufficiency

B. Brawny hyperpigmentation

C. Homan’s sign

D. Dependent rubor


1. 152: When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?



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